Sam Apple: The Warburg Effect—Otto Warburg's cancer metabolism theory

**Peter Attia** (0:11)
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My guest this week is Sam Apple. Sam's a freelance writer and author of several books, including one recently published called Ravenous about Otto Warburg, the Nazis, and the Cancer-Metabolism-Diet Connection, which we discuss in great detail during this show. Sam teaches in both the MA in Science Writing and MA in Writing programs at Johns Hopkins. Prior to coming to Johns Hopkins, Sam taught Creative Writing and Journalism at the University of Pennsylvania for 10 years. He holds a BA in English and Creative Writing from the University of Michigan and a Master in Fine Arts in Creative Nonfiction from Columbia University. In this episode, we go into great detail about the life story of Otto Warburg. We talk about his early upbringing in Germany, how he was influenced by some of the most influential, if not the most influential scientists in Germany. We talk about his seminal work prior to the Second World War and this odd manner in which he was able to remain in Germany unharmed during the Second World War, despite being both Jewish and gay.
The interesting part of the story, of course, is that much of his work would be largely forgotten by the time he died in 1970, and it would only be about 30 years later that some of his observations would come back to be relevant within the field of cancer biology. Of course, it's still not entirely clear if his hypothesis around that observation is correct. I personally do not think it was, but nevertheless, this makes for an interesting discussion. So without further delay, please enjoy my conversation with Sam Apple.
Hey, Sam, how are you doing today?
Good, good. Congratulations on the publication of your book very recently. Having never done that before, I can still only imagine it's akin to giving birth or something like that. Feels like the weight of the world off your shoulders after how much research you put into that.

**Sam Apple** (2:43)
Yeah, it's a huge relief just to be done. So I'm trying to think about a future project, but I feel like I need a few years just to relax now.

**Peter Attia** (2:54)
Oh, yeah, yeah. I imagine there's nothing more annoying than when you publish a book when somebody says, so what's your next book gonna be about? It's like, let me bask in this one for a while.
Like many books that go really deep into a topic, be it science or otherwise, they often start out as articles. And of course, you wrote a piece, was it 2015?

**Sam Apple** (3:16)
It came out in 2016

**Peter Attia** (3:19)
And it was the New York Times Magazine piece, correct?
And I remember that quite well. You and I had spoken quite a bit before then. And I know that that sort of ultimately led to the work that went into this book. But more broadly speaking, what attracted you to this topic of Warburg, cancer, metabolism, the era of Nazi Germany, and science in that era? What gravitated you to that?

**Sam Apple** (3:43)
Like so many people in this world, I was influenced by Taubes at a fairly early stage. My interest in metabolism, I read some of his work, and that had led me to other authors and eventually to a lot of your work and your blog. So I had been interested in metabolism for a number of years, but I had not really thought of cancer as a metabolic disease or thought about cancer as being lumped with obesity and diabetes and heart disease. And when I started to read more about that and see that they clustered together and that you see the same pattern that begins in the 19th century of all these metabolic conditions growing more common, that's what really sort of sparked my curiosities.
Cancer isn't supposed to be metabolic like these other diseases. It's bad luck. It's mutations that are caused by environmental carcinogens or whatnot. So it just stayed in my mind, but I hadn't planned to write about it until I came across a mention of Warburg. I think it was just one sentence, 1923, a German scientist makes an important discovery about the metabolism of cancer cells.